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If you’ve been paying attention to billboards lately, odds are you’ve seen ads for a new type of margarine that supposedly lowers cholesterol. Of course, being the at-least-mildly skeptical consumer you are, you might assume this is unwarranted hype. But what if there is something to these new claims? And even if you don’t have high cholesterol, or don’t use margarine, what is all the fuss about, anyway?

In late May, Health Canada announced that compounds known as plant sterols and stanols, which can be more broadly classified as plant phytosterols, may be added to mayonnaise, margarines, yogourt and yogourt drinks, juices and salad dressings, for cholesterol-lowering purposes. In the case of Becel, their new product — already available in 30 other countries — known as pro.activ, is a margarine fortified with these very plant sterols, and it is likely to be the first of many similar products on the market.

Plant sterols and stanols, defined

So what is a plant sterol or a stanol, and what do they do? Put simply, they are naturally-occurring plant products with a structure similar to cholesterol that, when taken in sufficiently high doses, can lower both total and LDL (or the so-called “bad”) cholesterol in humans. Structurally, plant stanols are saturated (meaning that their chemical backbone doesn’t include any double bonds), while sterols are not. While the mechanism of their action is still being studied, it appears that sterols and stanols block the absorption of cholesterol in the intestine in equal amounts, and neither have any impact — good or bad — on so-called “good” (or HDL) cholesterol, or on triglycerides.

Up until now, plant sterols and stanols existed in natural forms only, but as a result of Health Canada’s decision (following the lead of the Food and Drug Administration in the United States), these compounds can now be added to food products for the purpose of promoting heart health. Companies using plant sterols and stanols can now make a number of nutrition claims on their product packaging, such as “Plant sterols help reduce [or help lower] cholesterol.”

Sterols, stanols & your cholesterol

So how much plant sterol or stanol does it take to lower your cholesterol? According to a meta-analysis of 41 randomized trials published in 2003, consumption of two grams of plant sterols or stanols per day resulted in a 10% reduction in LDL cholesterol. Translating that into absolute numbers, that means a reduction of 0.3 to 0.5 mmol/L for most individuals. So for an individual with an LDL of 5.0 mmol/L (a level that would typically necessitate use of a statin drug, even in a low-risk individual), the addition of two grams per day of sterols and stanols alone — without any other dietary changes — could bring LDL cholesterol down to a still-elevated, but more palatable level of 4.5 mmol/L. Of course, since the impact is on a percentage basis, that means that for people with borderline-elevated LDL-cholesterol (let’s say 3.5 mmol/L), the reduction would be more modest (to 3.2 mmol/L).

While the impact might not seem earth-shattering, when compared with the benefits obtained from other conventional cholesterol-management strategies, such the 7% reduction in LDL cholesterol you get from adding seven to 10 grams of soluble fibre to your diet (via more well-known cholesterol fighters such as oatmeal, ground flaxseed, or psyllium fibre), the plant sterols and stanols actually come out on top.

So how much margarine would you need to take to achieve these results? Becel recommends you include five teaspoons per day in your diet, which would provide the magic two grams of plant sterols per day. In more traditional servings, two teaspoons of pro.activ provides 0.8 grams of sterols, or about 40% of the target amount. Since pro.activ is calorie-reduced margarine, two teaspoons will set you back a relatively modest 30 calories (versus 80 calories for the same serving of traditional margarine, butter or olive oil), so even five teaspoons per day (adding up to 75 calories) wouldn’t be a caloric deal-breaker.

Fortification or bust?

With literally dozens of products fortified with sterols and stanols already on the U.S. market, expect many to emerge north of the border in the coming months. But is fortification the only way to go? According to the evidence, it would be very difficult to obtain the full two grams any other way: While nuts, seeds, whole grains (especially rye), vegetable oils (especially canola oil), green leafy vegetables and avocados all contain sterols and stanols, most do so in concentrations of less than 100 mg per 100 gram serving (and 100 grams of most of these foods — equivalent to 3.5 ounces — would be an awful lot for most people to consume).

The bottom line

For vast majority of us, losing weight and eating more sensibly is a simple and safe way to take a bite out of cholesterol, but for those who are still struggling despite their best efforts, choosing sterol or stanol-fortified foods is an option. Either way, rest assured that you’ll be hearing a lot more about sterols and stanols in the very near future.

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